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      The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the Extended Prevalence of Infection in Intensive Care study.

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          Abstract

          To investigate the impact of various facets of ICU organization on outcome in a large cohort of ICU patients from different geographic regions.

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          Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

          Linda Aiken (2002)
          Article 0 comments Cited 425 times – based on 0 reviews     Review now
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            Nurse-staffing levels and the quality of care in hospitals.

            Jack Needleman, Peter Buerhaus, Soeren Mattke … (2002)
            It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes, differences in the nursing care needed for each hospital's patients, and other variables. The mean number of hours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by licensed practical nurses, and 2.4 hours by nurses' aides. Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of care per day provided by registered nurses were associated with a shorter length of stay (P=0.01 and P<0.001, respectively) and lower rates of both urinary tract infections (P<0.001 and P=0.003, respectively) and upper gastrointestinal bleeding (P=0.03 and P=0.007, respectively). A higher proportion of hours of care provided by registered nurses was also associated with lower rates of pneumonia (P=0.001), shock or cardiac arrest (P=0.007), and "failure to rescue," which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of "failure to rescue" (P=0.008). We found no associations between increased levels of staffing by registered nurses and the rate of in-hospital death or between increased staffing by licensed practical nurses or nurses' aides and the rate of adverse outcomes. A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.
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              The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.

              Robert Kane, Tatyana Shamliyan, Christine Mueller … (2007)
              To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) [odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86-0.96], in surgical (OR, 0.84; 95% CI, 0.80-0.89), and in medical patients (OR, 0.94; 95% CI, 0.94-0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56-0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36-0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79-0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86). Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Crit. Care Med.
                Title: Critical care medicine
                ISSN (Electronic): 1530-0293
                ISSN (Print): 0090-3493
                Publication date (Electronic): Mar 2015
                Volume: 43
                Issue: 3
                Affiliations
                [1 ] 1Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany. 2Department of Critical Care, St George's Healthcare NHS Trust, London, United Kingdom. 3Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, Canada. 4Center for Clinical Research and Scholarship, Rush University Medical Center, Chicago, IL. 5Department of Intensive Care, Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 6Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. 7Department of Intensive Care Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 8Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Queensland, Australia. 9Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
                Article
                DOI: 10.1097/CCM.0000000000000754
                PubMed ID: 25479111
                SO-VID: 8b7c875b-4d43-4c5c-9eba-b93498d09b33
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